Washington Medical Bill Checker

Washington medical bill laws

Surprise billing

Applies to state-regulated plans, public and school employee plans, and self-funded plans that opt in: an out-of-network provider or facility may not balance bill you for emergency care, nonemergency care at certain in-network facilities, or air ambulance services. (RCW 48.49.020)

State surprise billing laws reach plans the state regulates, such as most individual plans and fully insured employer plans. A self-funded employer plan follows the federal No Surprises Act, and a state law reaches it only if the plan opted in.

Ground ambulance

For plans issued or renewed on or after January 1, 2025, an out-of-network ground ambulance may not balance bill you for covered ground ambulance services; paying your in-network cost sharing satisfies what you owe. (RCW 48.49.200)

A state ambulance law reaches the plans it names, usually state-regulated plans such as individual plans and fully insured employer plans. It generally does not reach a self-funded employer plan, and the federal No Surprises Act does not cover ground ambulance.

Hospital financial assistance

Hospitals in large health systems must treat patients at or below 300% of the poverty level as charity care for their full patient responsibility, with discounts up to 400%. Other hospitals: free at or below 200%, discounts up to 300%. (RCW 70.170.060)

• hospitals in health systems with three or more acute hospitals, and certain large hospitals: free care at or below 300% of the guideline ($99,000 a year for a household of four); discounted care up to 400% ($132,000 for four).
• all other hospitals: free care at or below 200% of the guideline ($66,000 a year for a household of four); discounted care up to 300% ($99,000 for four).

Conditions in the law: Covers the patient responsibility portion of hospital charges (insured or uninsured). Large-system hospitals: 75% off at 301-350%, 50% off at 351-400%. Other hospitals: 75% off at 201-250%, 50% off at 251-300%. Discounts (not the free tier) may be reduced based on assets.

Medical debt

• Hospitals, physician groups and their professional partners may not furnish medical debt to credit reporting agencies, and a debt they report is void. Collection agencies may not report medical debt adversely, and credit reports may not include medical debt. (RCW 70.41.400(2); RCW 19.16.250(28)(a)(iii); RCW 19.182.040(1)(g))
• Prejudgment interest charged or collected on medical debt may not exceed 9%. (RCW 19.52.010(2))
• Collection agencies may not collect hospital debt while they know a charity care application or appeal is pending. On medical debt, they must provide a free itemized statement on request and stop collecting until they do. (RCW 19.16.250(28)-(29))

In an October 2025 interpretive rule, the CFPB said it reads federal credit reporting law as generally preempting state laws on credit report contents; the rule also says courts decide such questions (CFPB interpretive rule, 90 FR 48710 (Oct. 28, 2025)).

Complaints about a state-regulated plan go to the Washington Office of the Insurance Commissioner.

How the No Surprises Act limits surprise bills

The No Surprises Act covers people in job-based plans, individual plans and Marketplace plans. For emergency care, out-of-network air ambulance rides, and non-emergency care from an out-of-network clinician at an in-network hospital, hospital outpatient department, critical access hospital or ambulatory surgical center, you generally owe only your in-network cost-sharing. That payment counts toward your in-network deductible and out-of-pocket limit.

A provider can ask you to waive this protection for some scheduled care, but only with written notice at least 72 hours ahead (on the day you book, if you book less than 72 hours ahead, and at least 3 hours before care the same day). Some services can never be waived, including emergency medicine, anesthesiology, pathology, radiology, neonatology, assistant surgeons, hospitalists, intensivists and diagnostic services, and neither can care for unforeseen, urgent needs that come up during the visit.

Two gaps matter most. Ground ambulance rides are not covered by the federal law, and Medicare, Medicaid, VA, TRICARE and Indian Health Service coverage use their own billing protections instead. If a bill looks wrong, call the No Surprises Help Desk at 1-800-985-3059 or file a complaint with CMS.

Uninsured or self-pay: the good faith estimate dispute

If you have no insurance, or have private insurance and choose not to bill it, providers must give you a written good faith estimate when you schedule care at least 3 business days ahead, and whenever you ask. Short-term plans, health care sharing ministries, farm bureau plans and self-funded student plans count as uninsured for this rule. CMS says people in Medicare, Medicaid and other federal programs do not get a good faith estimate, even for a service their program does not cover. CMS is also not enforcing the rule that the main provider's estimate list other providers, so ask each provider you expect a bill from, such as the anesthesiologist or the lab, for its own estimate.

When a provider's bill comes in at least $400 above that provider's estimate, you can start the federal patient-provider dispute process within 120 days of receiving the initial bill. The fee is $25. While the dispute is open, the provider may not send the bill to collections and must pause late fees, and it should stop collection that has already started. The threshold is per provider, so compare each provider's bill with its own line on the estimate.

Hospital financial assistance (charity care)

Every nonprofit hospital must have a written financial assistance policy covering emergency and medically necessary care. It must publish the policy and an application, cap what it charges people eligible under the policy at the amounts it generally bills insured patients, wait at least 120 days after the first bill before actions like credit reporting or a lawsuit, and accept applications for at least 240 days after the first bill.

Some states go further and set income levels at which hospitals must give free or discounted care. Those levels are stated as a percentage of the federal poverty guidelines. For 2026, 100% of the guideline is $15,960 for one person and $33,000 for a household of four in the 48 contiguous states and DC (Alaska and Hawaii are higher). The hospital applies its own policy and decides each application.

Medical debt and credit reports

A federal rule that would have removed medical debt from credit reports was vacated by a federal court on July 11, 2025, so no general federal ban is in force. Federal law does keep one kind off reports: a veteran's medical debt for VA-authorized care from an outside provider, for a year after the care and once it is paid or settled (15 U.S.C. 1681c(a)(7)-(8); 1681a). The three national credit bureaus say they leave off paid medical collections and medical collections under $500, and wait 1 year before an unpaid one appears. Several states ban or limit medical debt reporting by law; the table below shows which. In an October 2025 interpretive rule the CFPB said it reads federal credit reporting law as generally preempting state laws on credit report contents, and that courts decide such questions (CFPB interpretive rule, 90 FR 48710 (Oct. 28, 2025)). In August 2026 a federal court in Texas held that federal law preempts a Texas law keeping certain out-of-network medical debt off credit reports, and barred Texas from enforcing it (Consumer Data Industry Ass'n v. State of Texas, No. 1:19-cv-876-RP (W.D. Tex. Aug. 10, 2026)).

Separately, federal debt collection law bars a collector from collecting any amount the law does not permit, which can include an amount the No Surprises Act does not allow (15 U.S.C. 1692f(1)).

For a nonprofit hospital, reporting a debt to a credit bureau counts as an extraordinary collection action, so the federal waiting period and the pause while you apply for financial assistance both apply to it.

Other states

Medical bill rules for every state and DC:

• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• District of Columbia
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Missouri
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming